Provider Demographics
NPI:1760218069
Name:WALTHER, IDA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:WALTHER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 E 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3148
Mailing Address - Country:US
Mailing Address - Phone:541-670-8390
Mailing Address - Fax:
Practice Address - Street 1:222 W KNOX AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4870
Practice Address - Country:US
Practice Address - Phone:509-354-2722
Practice Address - Fax:509-354-2727
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist